In atrial fibrillation (AF) the normal control of heart rhythm by the sinoatrial node is disrupted, leading to tachyarrhythmia. For the management of symptoms of AF, two possible strategies can be attempted: rate control, mainly with antiarrhythmic medications, or rhythm control, using drugs or performing radiofrequency catheter ablation. Over time, several clinical trials have been conducted comparing the two approaches to examine if one was superior to the other in terms of benefit for patients. Even though there was some discord among the trials, the net balance seems to favor the rate control strategy. In contrast, it was also seen that with strategies to control rate patients were more likely to evolve in permanent AF. Therefore, the debate is still open and new guidelines have been written to address the problem. Patients have to be identified as early as possible, and treatment should be evaluated individually.